FINACIAL POLICY
Our goal is to provide the highest quality of healthcare possible for our patients. In order to achieve this goal, we need your commitment as well.
We urge our patients to follow the doctor's recommendations for care. Please keep your appointments as scheduled or call our office within 24 hours to make any changes. In order to attain the level of achievement we both desire, care must be followed.
I authorize Carabasi Chiropractic Center to release any information deemed appropriate concerning my physical condition to any insurance company, attorney, or adjuster in order to process any claim for reimbursement of charges incurred by me. I authorize the direct payment to Carabasi Chiropractic Centerof any sum I now or hereafter owe by my attorney out of settlement of my case, and by any insurance company obligated to make payment to me or Carabasi Chiropractic Centerbased in whole or in part upon themadefor charges services received. I hereby appoint Carabasi Chiropractic Center authority to endorse and cash checks, drafts, or money orders made payable to the undersigned or as co-payee with this clinic for payments due for services rendered on behalf of the undersigned by Carabasi Chiropractic Center.
In order to file your claims in a timely manner, we need current, accurate insurance information for you and your dependents. We will do our best to confirm your eligibility and level of insurance coverage for care; however, it is ultimately your responsibility to know your own insurance benefits in relation to what your insurance covers and what it doesn't. Should your insurance carrier determine that any or all of our services are ineligible for payment, you will be billed directly for those services.
Late payment for non-coverage, deductible, and co-payment may be subject to an 18% annual finance charge, which will be added monthly to that account. If you have any questions about our financial policies, please ask to speak to our financial officer. If you need to make special arrangements, please ask. We will never deny care to anyone based solely on ability to pay. We will do everything possible to meet your financial needs.
Advanced Beneficiary Notice of NON-Coverage (ABN Your health insurance does not pay for everything, even some care that you or your health care provider have good reason to think you need. We expect your health insurance will not pay for items and services such as your initial visit and any chiropractic care deemed maintenance or wellness care by your carrier (as well as other items that may arise the infuture Signing below signifies that you want these items and services, but understand that they will not be billed to your insurance company. Therefore, you are responsible for payment and cannot appeal to your insurance carrier as they were not submitted and/or billed to them. This notice gives our opinion, not an official Medicare or other insurance carrier's decision. If you have other questions, please ask our front desk. Signing below means that you have received and understand this notice.